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Environmental Health Department <br />Complete sections 1 and 2. <br />4XC6529Lie. Plate # <br />209-641-4346 <br />12/10/25Date <br />12/20/25Date <br />Date <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />0 Wastewater disposal <br />Solid waste disposal <br /> Hot & Cold water for cleaning <br /> Store dry food/supplies <br />O Electrical hook-ups <br /> Toilet and handwashing <br />O Potable water <br />sKvehicle wash <br />SANJOAOUIN <br />■------COUNTY-- <br />Greatness grows here. <br />COMMISSARY AGREEMENT <br />Mobile Food Facility ♦ Caterer <br />he3. To be corr irisdiction outside of San Joaquin Co. <br />The commissary is located in ---------------------------------------------------County. The above food facility meets the <br />commissary requirements in California Health & Safety Code. The above checked services are available at the <br />above commissary. Please notify EHD if the status of their operating permit changes. <br />REHS Signature <br />FA# 209-464-9707 <br /> Bus. Phone 209-271-1741 <br />Qwner/Operator Salvador Buenrostro & Carmen Rivera <br />correct to the best of my knowledge, and meets the California Health & Safety Code requirements. If the food facility <br />or cancelled, the <br />If your commissary is located outside of San Joaquin County also complete section 3. <br /> <br />oleted by APPLICANT ' ■ ■ ------------------------------------ , <br />Business Name 3 Amigas Pupuseria <br />Owner/Operator Name Lilian Marquez <br />Business Mailing Address 4413 Mist Trail Dr. <br /> <br />' City Stockton StateCA Zip 95206 Bus. Ph. ^uia-04 i-h-o^o A|t ph <br />---------------------------------------------------■ hereby state that the above information is current, true and correct to <br />; the best of my knowledge and agree to utilize my approved commissary in accordance with California Health & <br />. Safety Code, and San Joaquin County Environmental Health Department (EHD) requirements. If the use of the <br />,.,x. commissary is discontinued, the permit holder must notify the EHD. Failure to notify this office may result in permit <br />. revocation and penalties. <br />Signature <br />Z: To be completed by COMMISSARY OWNER/OPERATOR <br />Commissary Name California Catering Truck Wash <br />Address 730 South California Street <br />City Stockton zip 95203 <br />Check all appropriate services provided: <br /> 3-compartment sink <br /> Food preparation <br />O Store refrigerated food <br /> Overnight parking <br />-------, hereby state that the information I have provided is current, true and <br />operator fails to comply with the conditions of this agreement, or if this agreement is modified <br />commissary owner shall notify the EHD immediately. <br />Signature__ MA. K/yekA